The WHO uses the term Female Genital Mutilation, and classifies FGM into four major types[21] (see Diagram 1), although there is some debate as to whether all common forms of FGC fit into these four categories, as well as issues with the reliability of reported data.[22]
Type I
The WHO defines Type I FGM as the partial or total removal of the clitoris (clitoridectomy),and/or the prepuce removal clitoral hood, see Diagram 1B. When it is important to distinguish between the major variations of Type I mutilation, the following subdivisions are proposed: Type Ia, removal of the clitoral hood or prepuce only; Type Ib, removal of the clitoris with the prepuce.[21] In the context of women who seek out labiaplasty, Stern opposes removal of the clitoral hood and points to potential scarring and nerve damage.[23]
[edit] Type II
The WHO's definition of Type II FGM is "partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (excision). When it is important to distinguish between the major variations that have been documented, the following subdivisions are proposed: Type IIa, removal of the labia minora only; Type IIb, partial or total removal of the clitoris and the labia minora; Type IIc, partial or total removal of the clitoris, the labia minora and the labia majora. Note also that, in French, the term excision is often used as a general term covering all types of female genital mutilation.[21]
[edit] Type III: Infibulation with excision
The WHO defines Type III FGC as narrowing of the vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or the labia majora, with or without excision of the clitoris (infibulation)."[1] It is the most extensive form of FGM, and accounts for about 10% of all FGM procedures described from Africa.[24] Infibulation is also known as "pharaonic circumcision."[25]
In a study of infibulation in the Horn of Africa, Pieters observed that the procedure involves extensive tissue removal of the external genitalia, including all of the labia minora and the inside of the labia majora. The labia majora are then held together using thorns or stitching. In some cases the girl's legs have been tied together for two to six weeks, to prevent her from moving and to allow the healing of the two sides of the vulva. Nothing remains but the walls of flesh from the pubis down to the anus, with the exception of an opening at the inferior portion of the vulva to allow urine and menstrual blood to pass through, see Diagram 1D. Generally, a practitioner deemed to have the necessary skill carries out this procedure, and a local anesthetic is used. However, when carried out "in the bush," infibulation is often performed by an elderly matron or midwife of the village, with no anesthesia used.[26]
A reverse infibulation can be performed to allow for sexual intercourse or when undergoing labor, or by female relatives, whose responsibility it is to inspect the wound every few weeks and open it some more if necessary. During childbirth, the enlargement is too small to allow vaginal delivery, and so the infibulation is opened completely and may be restored after delivery. Again, the legs are sometimes tied together to allow the wound to heal. When childbirth takes place in a hospital, the surgeons may preserve the infibulation by enlarging the vagina with deep episiotomies. Afterwards, the patient may insist that her vulva be closed again.[26]
This practice increases the occurrence of medical complications due to a lack of modern medicine and surgical practices.[citation needed]
A five-year study of 300 women and 100 men in Sudan found that "sexual desire, pleasure, and orgasm are experienced by the majority of women who have been subjected to this extreme sexual mutilation, in spite of their being culturally bound to hide these experiences."[27]
Most advocates of the practice continue to perform the procedure in adherence to standards of beauty that are very different from those in the west. Many infibulated women will contend that the pleasure their partners receive due to this procedure is a definitive part of a successful marriage and enjoyable sex life.[citation needed]
[edit] Type IV: Other types
There are other forms of FGM, collectively referred to as Type IV, that may not involve tissue removal. The WHO defines Type IV FGC as "all other harmful procedures to the female genitalia for non-medical purposes, for example, pricking, piercing, incising, scraping and cauterization."[21] This includes a diverse range of practices, such as pricking the clitoris with needles, burning or scarring the genitals as well as ripping or tearing of the vagina.[21] Type IV is found primarily among isolated ethnic groups as well as in combination with other types.[citation needed]
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